somerville small business covid-19 relief fund application · the city of somerville is now...
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Somerville Small Business COVID-19 Relief Fund Page 1
Somerville Small Business COVID-19 Relief Fund Application
City of Somerville Office of Strategic Planning & Community Development
The City of Somerville is now accepting applications for the Somerville Small Business COVID-19 Relief Fund, which will provide forgivable loans of up to $10,000 to Somerville businesses affected by the COVID-19 pandemic. This $1 million fund uses Community Development Block Grant monies from the U.S. Department of Housing and Urban Development.
Please note: • Applications are due on Monday, May 11 at 3pm. Applications received after this time
will not be accepted. If you are mailing your application for submission, it must bereceived before this date.
• Before starting your application, read the program guidelines .• You may only submit one application per EIN, SSN, ITIN.• Questions may be sent to [email protected].
1. Legal Business Name:
2. Doing Business As (DBA):
3. Business Street Address:
4. What are the legal names of the business owners (all who own at least 20% of the business)?
5. Business Website, if any:
6. Date business started:
7. Number of years operating in Somerville:
8. Was your business operating in Somerville prior to October 2019?
9. Please provide your tax ID:
For planning purposes only. To submit an application, visit SomervilleMA.gov/BizRelief.
Somerville Small Business COVID-19 Relief Fund Page 2
10. Is the tax ID you provided in #9 your:
___ Employer Identification Number (EIN)
___ Social Security Number (SSN)
___ Individual Taxpayer Identification Number
For planning purposes only. To submit an application, visit SomervilleMA.gov/BizRelief.
Somerville Small Business COVID-19 Relief Fund Page 3
Applicant Contact Information
11. Name:
12. Email Address, if any:
13. Phone Number
14. What is your role with respect to the business? (Owner? Other? Please specify.)
15. Legal Structure of Business:
__ Sole Proprietor
__ Cooperative
__ Corporation
__ S-Corp
__ Limited Liability Company
Other:
16. If you selected corporation, please specify the state of incorporation:
For planning purposes only. To submit an application, visit SomervilleMA.gov/BizRelief.
Somerville Small Business COVID-19 Relief Fund Page 4
17. What is your primary industry? Please note: Liquor and tobacco stores, cannabis stores, pawn shops, adult entertainment, and passive real estate investment businesses are not eligible to apply.
__ Childcare
__ Construction
__ Creative / Arts
__ Distribution / Logistics / Warehousing
__ Entertainment
__ Farming / Agriculture
__ Health and Wellness
__ Manufacturing
__ Personal Services (barber shops, nail salons, cleaners, landscaping, etc.)
__ Professional Services
__ Restaurant / Catering
__ Retail
__ Other:
For planning purposes only. To submit an application, visit SomervilleMA.gov/BizRelief.
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18. Please describe your business in one sentence:
19: To the best of your knowledge, how many employees did you have on each of the following dates (including yourself):
# of Full Time Employees # of Part Time Employees
March 1, 2019
March 1, 2020
Today
For planning purposes only. To submit an application, visit SomervilleMA.gov/BizRelief.
Somerville Small Business COVID-19 Relief Fund Page 6
HUD CDBG Eligibility
The funding source for the program is the United States Housing and Urban Development (HUD) Community Development Block Grant (CDBG) program. Eligibility for this program can be determined two ways, either by qualifying as an eligible microenterprise or by creating or retaining a low/moderate income job. Microenterprise 20. How many people live in your (business owner’s) household? (A household consists of one or more persons living in the same house, condominium or apartment. They may or may not be related.):
21. What is the estimated total annual household income? (Tip: You need to include the income of everyone living in the household. Also use your estimated annual income as of today, so if your income wend down recently due to COVID-19 or if someone in your household just lost a job, it may increase your ability to qualify.):
22. What best describes the owner’s ethnicity?
__ Hispanic/Latino
__ Not Hispanic/Latino
23. What best describes the owner’s race?
__ Black /African American
__ White
__ Native Hawaiian / Other Pacific Islander
__ Asian & White
__ American Indian / Alaskan Native & Black / African American
__ Asian
__ American Indian / Alaskan Native
__ American Indian / Alaskan Native & White
__ Black / African American & White
__ Other / Multiracial
For planning purposes only. To submit an application, visit SomervilleMA.gov/BizRelief.
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Job Creation/Retention
24. How many jobs do you plan to create or retain as a result of this award? (Tip: if you recently laid off employees because of COVID-19 and plan to bring some back, you can count the position as a created job. If you furloughed an employee and plan to bring them back, you can count that as a retained job). For expected salary, please indicate over what time period (hourly, weekly, monthly, or annually)
Created or Retained Position
Titles
# of Full
Time
# of Part
Time
Expected Salary
For planning purposes only. To submit an application, visit SomervilleMA.gov/BizRelief.
Somerville Small Business COVID-19 Relief Fund Page 8
COVID-19 Business Impact
25. List your monthly business expenses below. (You will be required to provide proof if you are awarded assistance and before you receive payment.)
Monthly lease / mortgage cost:
Monthly utility costs:
Monthly debt costs:
Monthly insurance costs:
Monthly payroll costs (as of now):
Monthly cost of goods (as of now):
What was your average monthly revenue prior to this crisis?:
26. How has your revenue been impacted by COVID-19?
__ Not impacted
__ Revenue declined by 10%-24%
__ Revenue declined by 25%-49%
__ Revenue declined by 50%-75%
__ Revenue declined by 76%-100%
For planning purposes only. To submit an application, visit SomervilleMA.gov/BizRelief.
Somerville Small Business COVID-19 Relief Fund Page 9
27. Are you offering alternative services or operating differently in light of COVID-19? (Check all that apply.)
__ Home delivery
__ In-store pickup
__ Online services
__ Other contactless services
__Staggered or limited hours
__ Different product offerings
__ Employee(s) able to work from home
__ Not applicable
__ Other:
28.What challenges do you anticipate that your business will face when it’s allowed to reopen? Do you think you’ll be limited due to expected social distancing guidelines? Please explain:
For planning purposes only. To submit an application, visit SomervilleMA.gov/BizRelief.
Somerville Small Business COVID-19 Relief Fund Page 10
Brick & Mortar Business
29. Business real estate status:
__ Business owns the commercial space
__ Business leases / rents the commercial space
__ Business is home-based
30. Business is located:
__ On the first floor within a commercial district
__ Within upper story space (second floor or above)
__ Other:
For planning purposes only. To submit an application, visit SomervilleMA.gov/BizRelief.
Somerville Small Business COVID-19 Relief Fund Page 11
Somerville Character
31. What best describes your business? :
__ Branch location of a national or regional chain of stores / office / service
provider, etc
__ Independently-owned franchise of a national or regional chain of stores / office
/ service provider/ etc.
__ Branch of a small chain native to Greater Boston or Massachusetts with five
locations or less.
__ Independently-owned Somerville-basedbusiness
32. Does your business provide a unique product or service? If so, please describe?:
33. Please describe how your business contributes to Somerville’s unique character:
For planning purposes only. To submit an application, visit SomervilleMA.gov/BizRelief.
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Use of City Funds
34. Please describe the amount of money needed to manage immediate working capital needs:
Rent:
Utilities:
Payroll:
Inventory:
35. The City would like to maximize the impact that awarded funds have on the current and future viability of your business. How much money do you need to manage immediate costs (the maximum award amount is $10,000)? What would you use that funding towards?:
For planning purposes only. To submit an application, visit SomervilleMA.gov/BizRelief.
Somerville Small Business COVID-19 Relief Fund Page 13
36. Have you applied for or received an SBA Economic Injury Disaster Loan (EIDL)?:
__ Didn’t apply
__ Applied, but haven’t heard yet
__ Application approved, but still waiting for a check
__ Received a check
37. Have you applied for the SBA Payroll Protection Program (PPP)?:
__ Didn’t apply
__ Applied, but haven’t heard yet
__ Application approved, but still waiting for a check
__ Received a check
For planning purposes only. To submit an application, visit SomervilleMA.gov/BizRelief.
Somerville Small Business COVID-19 Relief Fund Page 14
Public Construction Impact
38. Was your business impacted by public construction projects during 2019?
__ Yes
__ No
39. Which projects caused the impact?
__ Union Square / Somerville Ave Utility & Streetscape Project
__ Green Line Extension (GLX)
__ Beacon St Reconstruction
__ Other:
40. If yes, briefly describe how and to what extent your business was negatively impacted by
construction:
For planning purposes only. To submit an application, visit SomervilleMA.gov/BizRelief.
Somerville Small Business COVID-19 Relief Fund Page 15
Disadvantaged Business
41. Please check that all apply to 51% or more of your business ownership.
__ Minority owned
__ Woman owned
__ Veteran owned
__ Not a minority owned, veteran owned, or woman owned business
For planning purposes only. To submit an application, visit SomervilleMA.gov/BizRelief.
Somerville Small Business COVID-19 Relief Fund Page 16
Eligibility Checklist
Note: You must respond yes to the following requirements in order to qualify for HUD CDBG funding.
42. I certify that my business is engaged in activites that are regulated by the City of Somerville and that I hold a license or permit associated to that regulation (excludes federally prohibited items like cannabis.)
__ Yes __No
43. I agree to provide documentation to help verify the economic hardship suffered as a result of COVID-19; including tax returns, financial statements, and other financial data, and that the financial documentation is true and accurate. This information will be used for eligibility of the program only and not shared with other City departments.
__ Yes __ No
44. The Economic Development team will reach out after the loan is distributed to solicit data about how you used program funding and the economic impact it had on your business. This may require information on the jobs created and retained, changes in sales numbers, or other metrics. For businesses with more than 5 employees, payroll forms will be required after funds have been dispersed in order to prove that jobs were created or retained as a result of this assistance. Participation in this data gathering is a requirement of accessing this funding.
__ Yes I agree to share data about the economic impact of the grant
__ No, I do not agree
For planning purposes only. To submit an application, visit SomervilleMA.gov/BizRelief.
Somerville Small Business COVID-19 Relief Fund Page 17
Additional Questions
Answers to these questions won’t impact your application.
45. Do you have business interruption insurance?
__ Yes __ No
46. Do you have a business plan?
__ Yes __ No
47. Do you have access to a printer?
__ Yes __ No
48. I have read and understood the Somerville COVID-19 Emergency Relief Fund Program
Guidelines and agree to the terms. I understand that knowingly making a false statement to
obtain a forgivable loan from the City of Somerville is punishable under state law.
Signed:
______________________________________________
Date:
For planning purposes only. To submit an application, visit SomervilleMA.gov/BizRelief.